Taussig Cancer Institute's Program for Gastrointestinal Cancers is a multidisciplinary program that cares for patients with a variety of gastrointestinal cancers.
Treatment of these gastrointestinal cancers requires careful and close collaboration with a number of departments including colorectal surgery, general surgery, gastroenterology, interventional radiology and radiation oncology. Patients are offered a wide variety of clinical trials, which range from large randomized trials sponsored by the National Cancer Institute, cooperative group trials, industry-sponsored trials and institutional local trials of experimental drugs.
Patients can also elect to receive standard of care therapies administered with the latest state-of-the-art techniques for gastrointestinal cancer.
What Are Carcinoid Tumors?
Carcinoid tumors are slow-growing malignancies (cancerous growths) that usually occur in the ileum (the lower section of the small intestine), the appendix, and the rectum. These tumors secrete large amounts of normal body chemicals such as serotonin, bradykinin, histamine, and prostaglandins. People who have high levels of these chemicals in their bodies may have carcinoid tumors.
How are carcinoid tumors classified?
One of the biggest concerns about a cancer diagnosis is whether the cancer has spread beyond its original location. Carcinoid tumors can spread to other organs, including the liver, lungs, bone, lymph nodes and ovaries. Carcinoid tumors are classified by their location in the body in the following manner:
- Localized: the tumors appear in the appendix, small or large intestine, rectum, or stomach, and have not spread from the original site.
- Regional: the cancer has moved from these sites to lymph nodes or nearby tissues.
- Metastatic: the cancer has spread to other sites in the body, far from the original location.
What are the symptoms of carcinoid tumors?
Patients who have carcinoid tumors may not have symptoms and thus may not be aware that they have the disease. Symptoms often develop only after the tumor has metastasized (spread), and include the following:
- flushing of the face and neck
- abnormal heartbeat
- abdominal pain
- weight loss
- low blood pressure
How are carcinoid tumors diagnosed?
If your doctor thinks you may have carcinoid tumors, he or she will ask you about your health history to learn if you have had other diseases. He or she will also perform a physical examination to see if you have any signs of this disease.
The doctor may also conduct other tests, including:
- Complete blood count (to determine the number of red blood cells)
- Blood chemistry (which looks for substances in the blood that cause disease)
- 24-hour urine test, to check for higher levels of hormones that could indicate a carcinoid tumor
How are carcinoid tumors treated?
There are several methods for treating carcinoid tumors, including surgery, radiation therapy, chemotherapy, and drug therapy.
The main treatment for carcinoid tumors is surgery to remove the tumors. Surgical methods include the following:
- Resection: the surgeon takes out either the part of the organ that contains cancer, or the entire organ. If the tumor is in the bowel (large intestine), the tumor and part of the bowel are removed and the remaining sections of the bowel are joined together (anastamosis).
- Local excision: removal of the tumor and some of the tissue surrounding it
- Fulguration: the tumor is burned off with a tool that produces an electric current.
- Cryosurgery: the tumor is frozen and killed with an instrument.
- Radiofrequency ablation: an instrument with electrodes is inserted into the body and kills cancer cells with thermal energy.
Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. Chemotherapy is given by mouth or injected into the patient's muscle or vein.
High levels of radiation are used to kill cancer cells or prevent them from multiplying, while minimizing damage to healthy cells. The radiation may be delivered by special equipment that directs the radiation from outside the body (external radiation). Radiation may also come from an implant, a small container of radioactive material placed into or near the tumor (internal radiation).
Biologic therapy, also called immunotherapy, uses the body's immune system to destroy cancer cells. Biologic therapies are used to repair, stimulate, or enhance the immune system's natural anti-cancer function.
The drug octreotide can be given, which binds to carcinoid cells and reduces the production of serotonin and other chemicals. It is an effective way to treat carcinoid syndrome.
Treatment of carcinoid tumors and gastrointestinal cancers depends on where they are located in the body:
- Localized: carcinoid tumors that appear in the appendix, rectum, colon, ileum, or pancreas are usually treated with local excision and/or surgery, or fulguration (for rectal tumors).
- Regional: if the cancer has spread beyond its original site to other tissues and/or to lymph nodes, it is usually removed by surgery. Tissues and lymph nodes located near the tumor may be removed, too. The patient may also receive palliative therapy to help relieve symptoms in order to be as comfortable as possible.
- Metastatic: if the cancer has spread to other parts in the body far from the original site and if the patient is having symptoms, he or she may receive one or more of the treatments listed above in order to relieve pain.